*Case Study* A 2-year-old boy fell from a backyard gym set. His shoulder and upper arm became very swollen shortly after the fall. The boy’s mother took him to the emergency department a few hours after th incident because he was complaining of pain. On physical examination, the physician noted that large hematoma had formed in the upper part of the boy’s right arm. There was no history of surgery (he had not been circumcised), injury, or illness. The boy was receiving no medication. Emergency department treatment consisted of aspirating the hematoma Subsequent to this treatment, the boy began to bleed extensively. He was admitted to the hospital. The following laboratory tests were ordered: a hemoglobin and hematocrit, platelet count, and bleeding time. Because the bleeding continued, a type and crossmatch for two units of fresh blood were ordered on a standby basis. Additional information from the mother revealed that the boy’s cousin had “bleeding problem.” Laboratory Data Hemoglobin 8.0 g/L Hematocrit 26% Platelet count 200 × 109/L (normal, 150 to 450 × 109/L) Bleeding time 5 minutes (normal, 3 to 8 minutes) Subsequent coagulation profile tests were ordered before the transfusion of two units of fresh whole blood. The results of these tests were as follows: PT 12 seconds (normal, 11 to 15 seconds) aPTT 60 seconds (normal, 28 to 35 seconds) Thrombin time–reptilase method 20 seconds (normal, 18 to 22 seconds) Do the laboratory data support a diagnosis of a disorder of hemostasis? Which disorder if applicable is to be suspected above What types of disorders can be preliminarily identified by the tests that were performed? What is Mixing test, and how relevant will it be in this patient’s diagnosis? What confirmatory tests must be done in this case? How could the presence of a Lupus anticoagulant affect the patients results if present?
*Case Study*
A 2-year-old boy fell from a backyard gym set. His shoulder and upper arm became very swollen shortly after the fall. The boy’s mother took him to the emergency department a few hours after th incident because he was complaining of pain. On physical examination, the physician noted that large hematoma had formed in the upper part of the boy’s right arm. There was no history of surgery (he had not been circumcised), injury, or illness.
The boy was receiving no medication. Emergency department treatment consisted of aspirating the hematoma Subsequent to this treatment, the boy began to bleed extensively. He was admitted to the hospital. The following laboratory tests were ordered: a hemoglobin and hematocrit, platelet count, and bleeding time. Because the bleeding continued, a type and crossmatch for two units of fresh blood were ordered on a standby basis. Additional information from the mother revealed that the boy’s cousin had “bleeding problem.”
Laboratory Data
Hemoglobin 8.0 g/L
Hematocrit 26%
Platelet count 200 × 109/L (normal, 150 to 450 × 109/L)
Bleeding time 5 minutes (normal, 3 to 8 minutes)
Subsequent coagulation profile tests were ordered before the transfusion of two units of fresh whole blood.
The results of these tests were as follows:
PT 12 seconds (normal, 11 to 15 seconds)
aPTT 60 seconds (normal, 28 to 35 seconds)
Thrombin time–reptilase method 20 seconds (normal, 18 to 22 seconds)
- Do the laboratory data support a diagnosis of a disorder of hemostasis? Which disorder if applicable is to be suspected above
- What types of disorders can be preliminarily identified by the tests that were performed?
- What is Mixing test, and how relevant will it be in this patient’s diagnosis?
- What confirmatory tests must be done in this case?
- How could the presence of a Lupus anticoagulant affect the patients results if present?
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